Provider Demographics
NPI:1295393221
Name:SURYAPRAKASH, SHRUTHI (MD)
Entity type:Individual
Prefix:MS
First Name:SHRUTHI
Middle Name:
Last Name:SURYAPRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 ARMAND DR APT 203
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-8961
Mailing Address - Country:US
Mailing Address - Phone:734-331-5974
Mailing Address - Fax:
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3300
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2025-09-25
Deactivation Date:2020-01-17
Deactivation Code:
Reactivation Date:2020-03-18
Provider Licenses
StateLicense IDTaxonomies
TN657252080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology